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Heart Disease, Sex Differences, & Mental Stress

Heart Disease, Sex Differences, & Mental Stress

Clinical research has demonstrated that there is a relationship between mental stress and cardiovascular diseases, including ischemic heart disease (IHD). Studies indicate that emotional stress is associated with IHD and has been linked to clinical events, but few investigations have explored sex-specific differences in the psychobiological responses to mental stress. To address this research gap, Zainab Samad, MD, MHS, and colleagues had a study published in the Journal of the American College of Cardiology that examined differential psychological and cardiovascular responses to mental stress between men and women with stable IHD. For the analysis, 254 men and 56 women with stable IHD underwent psychometric assessments, transthoracic echocardiography, and platelet aggregation studies at baseline and after three mental stress tasks, which included 1) a math test, 2) a mirror tracing test, and 3) an anger recall test.             Most baseline characteristics were similar between women and men with known IHD, including heart rate, blood pressure, and left ventricular ejection fraction (LVEF). However, women were more likely to be non-white, living alone, and unmarried. They also had higher levels depression and anxiety at baseline. At rest, women had higher platelet aggregation responses to serotonin and epinephrine than men. Important Findings The investigators defined mental stress-induced myocardial ischemia (MSIMI) as the development or worsening of regional wall motion abnormalities, reductions of LVEF to 8% or lower, and/or ischemic ST-segment changes on electrocardiogram during one or more of the three mental stress tasks. “Women had more MSIMI than men and expressed more negative emotions and fewer positive emotions while doing the stressful tasks,” says Dr. Samad. Women were also more likely to experience decreased...
ACC 2015

ACC 2015

New research was presented at ACC.15, the annual scientific sessions of the American College of Cardiology, from March 14 to 16 in San Diego. The features below highlight some of the studies that emerged from the conference. CPAP Decreases Acute HF Rehospitalization Rates The Particulars: Prior research has identified sleep-disordered breathing in heart failure (HF) as a significant risk factor for patients with different forms of HF that can impact clinical outcomes. However, data are lacking on whether compliance with continuous positive airway pressure (CPAP) treatment influences readmission rates among patients with acute HF and sleep apnea. Data Breakdown: Patients who had been hospitalized for HF and determined to have sleep apnea within 4 weeks of discharge were examined for a study. Among those who were compliant with their CPAP treatment, average pulmonary artery systolic pressure levels decreased, whereas non-compliant patients experienced an increase in these levels. The average number of rehospitalizations decreased by 0.8 visits from baseline to 6 months follow-up in the compliant group but increased by 1.1 visits in the non-compliant group. Take Home Pearl: Compliance with CPAP therapy appears to reduce 6-month readmission rates among patients with acute decompensated HF who are found to have sleep apnea shortly after being discharged from the hospital. Sedentary Behavior & Coronary Artery Calcification The Particulars: Physical activity has been shown to have multiple cardiovascular benefits in numerous studies, but no definitive relationship has been shown between physical activity and coronary artery calcification (CAC). Little is known about the relationship between sedentary behavior and CAC, independent of physical activity. Data Breakdown: For a study, researchers analyzed data on more...
Touch

Touch

Surgery is a contact sport. It seems obvious that surgeons touch their patients. We enter their bodies in a way that is both impersonal and incredibly intimate. But beyond the act of operating on someone, touch is a therapeutic tool. I never leave a patient’s room or the exam room without touching my patient in a nonclinical way. It may be a handshake, a light touch on the arm, a reassuring squeeze to the top of a foot as I pass the end of their bed. It has become so internalized that I hardly notice. But the patient does. They tell me that it helps them recognize that they are still a person and not totally consumed by their disease. The longer the patient is ill, the more important the touch becomes. I always knew I wanted to be a surgeon. From the time I started grade school, it’s all I ever wanted to be. It was one thing to want to be something but another to really understand what it meant to reach inside another body. The first time, as a third year medical student, that a cardiac surgeon invited me to lay my hand on the beating heart, I fell in love. The feel of the life pumping through the chambers was intoxicating. “Touch is a therapeutic tool. It may be a handshake, a light touch on the arm, a reassuring squeeze to the top of a foot as I pass the end of their bed.”   Over time, with training, I learned to distinguish the feel of diseased from healthy tissue; the hard scabrous feel of...
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